Orthopedic Coding Alert

Question: The physician completed debridement and repair of the sartorius tendon. He drilled several holes into the anterior-superior iliac spine to induce vascular inflow and then used fiberwire through the bone to repair the origin of the sartorius and tensor fascia lata. I plan to report an ‘unlisted procedure' code, but don't know the best procedure to compare it to for reimbursement.  What are your suggestions?

Minnesota Subscriber

Answer: Code the surgery with 27299 (Unlisted procedure, pelvis or hip joint).

The drilling of holes (microfracture) is similar to several procedures. Your best option for a comparable procedure to help guide reimbursement could be 26992 (Incision, bone cortex, pelvis and/or hip joing [e.g., osteomyelitis or bone abscess]), which had a national average reimbursement of $891.93 for facility or non-facility settings in 2009. You describe an unusual case, however, so check the details in the operative report before deciding on a comparable code.

Comparison note: Coders sometimes ask if they can list procedures from different sections of CPT to suggest reimbursement for unlisted procedure codes. Turning to different sections is permitted when you're searching for the best comparison. Be sure to include a letter with your claim explaining your surgeon's procedure and why you're reporting an ‘unlisted' code.